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See a sample rate comparisonCPT 97763 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Orthotic(S)Prosthetic(S) Mana, Orthotic(S)Prosthetic(S) Management Andor Training Upper Extremity(Ies) Lower Extremity(Ies) Andor Trunk Subsequent Orthotic(S)Prosthetic(S) Encounter Each 15 Minutes He Performance Of An Activity (Eg Managing Time Or Schedules Initiating Organizing And Sequencing
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | GO - Services delivered under an outpatient occupational therapy plan of care KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
| Medicare Fee Schedule | $50.10 national non-facility rate (2026) · View Medicare rates for 97763 |
| Medicaid Fee Schedule | $40.66 median of the 7 states in the free preview · View Medicaid rates for 97763 |
National average reimbursement for CPT 97763 by major payers:
$63.59
$53.97
$65.37
$63.90
Compare published rates across providers.
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CPT 97763
5 of 25 sample ratesHigher to lower in this preview
Nora Lersch
$165.80Published rateHannah Pappas
$113.20Published rateMatthew Berryman
$54.13Published rateJaclyn Mclaughlin
$53.88Published rateBenchmark Physical Therapy Of Oregon LLC
$27.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 97763 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97763 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97763 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97545-CPT | Low | Work Hardening/Condit Initial 2 Hrs |
| 97546-CPT | Low | Work Hardeningconditioning E, Work Hardeningconditioning Each Additional Hour (Listseparately In Addition To Code For Primary Procedure) Work Hardeningconditioning Each Additional Hour (List |
| 97760-CPT | Low | Orthotic(S) Management And Training (Including Assessment And Fitting When Not Otherwise Reported) Upper Extremity(Ies) Lower Extremity(Ies) And/Or Trunk Initial Orthotic Encounter Each 15 Minutes (Desc Revised 1/1/2018) |
| 97763-CPT | Low | Orthotic(S)Prosthetic(S) Mana, Orthotic(S)Prosthetic(S) Management Andor Training Upper Extremity(Ies) Lower Extremity(Ies) Andor Trunk Subsequent Orthotic(S)Prosthetic(S) Encounter Each 15 Minutes He Performance Of An Activity (Eg Managing Time Or Schedules Initiating Organizing And Sequencing |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97763. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97763 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
CPT 97763 reports a subsequent orthotic or prosthetic management and training visit for the upper extremities, lower extremities and/or trunk, per 15 minutes.
The initial orthotic encounter uses 97760 and the initial prosthetic training uses 97761. Because 97763 is billed in 15-minute units, Medicare applies its time rules for counting units.
Medicare pays CPT 97763 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 97763 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.